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Ambulatory blood pressure, endothelial perturbation, and microvascular complications in type 2 diabetes.
MedLine Citation:
PMID:  21219847     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Diabetic vascular complications constitute leading causes of blindness, renal failure, and cardiovascular morbidity and mortality world-wide. We studied haemodynamic and structural abnormalities associated with the development of microvascular complications and evaluated the effect of intervention with antihypertensive agents on these risk factors and complications in type 2 diabetic patients (T2DM). Retinal thickness, urinary albumin excretion rate, and transcapillary escape rate of albumin were strongly associated in T2DM patients with maculopathy, suggesting that macular oedema is a marker of generalised vascular hyperpermeability in T2DM. Plasma from T2DM patients with maculopathy stimulated the expression of E-selectin in cultured endothelial cells. Reduced nocturnal blood pressure decline ("non-dipping") and elevated pulse pressure (PP) were associated with micro- and macrovascular complications and predicted progression of nephropathy in T2DM subjects. Non-dipping and elevated PP were associated with increased plasma levels of markers of endothelial activation in T2DM patients, suggesting that endothelial perturbation could represent a pathophysiological link between these haemodynamic risk factors and the development of vascular complications in T2DM. 4 months treatment with losartan 50 mg o.d. did not ameliorate macular oedema in T2DM patients with maculopathy. 12 months dual blockade of the renin-angiotensin system with candesartan and lisinopril reduced ambulatory PP levels compared with high-dose lisinopril monotherapy in hypertensive T2DM subjects.
Authors:
Søren Tang Knudsen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Danish medical bulletin     Volume:  57     ISSN:  1603-9629     ISO Abbreviation:  Dan Med Bull     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2011-01-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0066040     Medline TA:  Dan Med Bull     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  B4145     Citation Subset:  IM    
Affiliation:
Medical Department, Regional Hospital Silkeborg, Falkevej 1-3, 8600 Silkeborg. Denmark. stk@dadlnet.dk.
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